Pneumonia Flashcards
is the result of an inflammatory process that primarily affects the gas exchange area of the lung.
Pneumonia, or pneumonitis with consolidation,
This process of fluid transfer is called
effusion
move into the infected area to engulf and kill invading bacteria on the alveolar walls.
Polymorphonuclear leukocytes
Polymorphonuclear leukocytes move into the infected area to engulf and kill invading bac- teria on the alveolar walls. This process has been termed ______
surface phagocytosis
If the infection is overwhelming, the alveoli become filled with fluid, RBCs, polymorphonuclear leukocytes, and macrophages. When this occurs, the lungs are said to be ______
consolidated
Atelectasis is often asso- ciated with patients who have _____
aspiration pneumonia
The major pathologic or structural changes associated with pneumonia are as follows: / Anatomic Alterations of the Lungs
• Inflammation of the alveoli
• Alveolar consolidation
• Atelectasis (e.g., aspiration pneumonia)
Causes of pneumonia include
bacteria, viruses, fungi, protozoa, parasites, tuberculosis, anaerobic organisms, aspiration, and the inhalation of irritating chemicals such as chlorine.
Pneumonia is an ______ disease because its symptoms vary greatly, depending on the patient’s specific underlying condi- tion and the type of organism causing the pneumonia.
insidious
The terms __________ often refer to the anatomic location of the inflammation
bronchopneumonia,
lobar pneumonia,
interstitial pneumonia
______ is characterized by a patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma.
Bronchopneumonia
_______ usually involves both lungs and is seen more often in the lower lobes of the lung.
Bronchopneumonia
_______ is a widespread or diffuse alveolar inflammation and consoli- dation.
Lobar pneumonia
________ is typically the end result of a severe or long-term bronchopneumonia in which the infec- tion has spread from one lung segment to another until the entire lung lobe is involved.
Lobar pneumonia
_______ is usually a diffuse and often bilateral inflammation that primarily involves the alveolar septa and interstitial space.
Interstitial pneumonia
the ________ do not migrate into the alveoli—they remain in the alveolar interstitial spaces.
polymorphonuclear leukocytes
____ cause interstitial pneumonias.
Mycoplasma pneumonia and other viruses
most interstitial pneumonias cause only ______ and usually resolve without consequences.
minor permanent alveolar damage
Risk Factors for Pneumonia
• Age over 65 years
• Aspiration of oropharyngeal secretions
• Viral respiratory infections
• Chronic illness and debilitation (e.g., diabetes melli-
tus, uremia)
• Chronic respiratory disease (COPD, asthma, cystic
fibrosis)
• Cancer (especially lung cancer)
• Prolonged bed rest
• Tracheostomy or endotracheal tube
• Abdominal or thoracic surgery
• Rib fractures
• Immunosuppressive therapy
• AIDS
When both lungs are involved, the condition is sometimes called _______ by laypersons.
double pneumonia
Although the lay term “ _______” has no clinical significance, it is often used to describe a mild case of pneumonia.
walking pneumonia
______ refers to a pneumonia acquired from normal social contact
Community-acquired pneumonia (CAP)
Community-Acquired Pneumonia
• Streptococcus pneumonia
• Staphylococcus aureus (also hospital-acquired
pneumonia)
• Haemophilus influenza
• Legionella pneumophila
• Enterobacteriaceae (Klebsiella pneumonia)
• Pseudomonas aeruginosa (also hospital-acquired
pneumonia)
Community-Acquired Atypical Pneumonia
• Mycoplasma pneumonia
• Chlamydia spp.—C. pneumonia, C. psittaci, C. tracho-
matis, and C. burnetii (Q fever)
• Viruses: respiratory syncytial virus, parainfluenza virus
(children); influenza A and B (adults); adenovirus (mili- tary recruits), human metapneumovirus
Hospital-Acquired Pneumonia (Nosocomial Pneumonia)
• Gram-negative bacilli belonging to Enterobacteriaceae
(Klebsiella spp., Serratia marcescens, Escherichia coli) and Pseudomonas spp., and Staphylococcus aureus (usually methicillin-resistant)
• Ventilator-acquired pneumonia (P. aeruginosa, Klebsi- ella, and S. aureus)
Aspiration Pneumonia
• Anaerobic oral flora (Bacteroides, Prevotella, Fusobac- terium, Peptostreptococcus), admixed with
aerobic bacteria (S. pneumonia, S. aureus, H. influenza, and Pseudomonas aeruginosa)
Chronic Pneumonia
• Granulomatous: Mycobacterium tuberculosis and atypi- cal mycobacteria, Histoplasma capsulatum, Coccidioi- des immitis, Blastomyces dermatitidis
• Candida albicans, Cryptococcus neoformans, and Aspergillus
• Nocardia
• Actinomyces
Necrotizing Pneumonia and Lung Abscess
• Anaerobic bacteria (extremely common), with or without mixed aerobic infection S. aureus, K. pneumonia, Strep- tococcus pyogenes, and type 3 pneumococcus (uncommon)
Pneumonia in the Immunocompromised Host
• Cytomegalovirus
• Pneumocystis jirovecii
• Mycobacterium avium complex (MAC)
• Invasive aspergillosis
• Invasive candidiasis
• “Usual” bacterial, viral, and fungal organisms
(commonly called pneumococcal pneumonia) accounts for more than 80% of all the bacterial pneumonias
Streptococcal pneumonia. Streptococcus pneumoniae
The organism is a gram-positive, nonmotile coccus that is found singly, in pairs (called diplococci), and in short chains.
Streptococcal pneumonia. Streptococcus pneumoniae
There are more than 80 different types of S. pneumoniae. Serotype ____ organisms are the most virulent.
3
Most strains of S. pneumoniae are sensitive to _____ and its derivatives.
penicillin
Streptococcus pneumoniae (S. pneumoniae) is also commonly cultured from the sputum of patients having an acute exacerbation of ______
chronic bronchitis
Staphylococcal pneumonia. There are two major groups of Staphylococcus:
(1) Staphylococcus aureus,
(2) Staphy- lococcus albus and Staphylococcus epidermidis
________ which is responsible for most “staph” infections in humans,
Staphylococcus aureus,
which are part of the normal skin flora.
Staphylococcus albus and Staphylococcus epidermidis,
The ________ are gram-positive cocci found singly, in pairs (called diplococci), and in irregular clusters
staphylococci
____ often follows a predisposing virus infection and is seen most often in children and immunosuppressed adults.
Staphylococcal pneumonia
are a common cause of hospital-acquired pneumonia or noso- comial pneumonia and are becoming increasingly antibiotic resistant—thus the term multiple drug–resistant S. aureus (MDRSA) organisms (some centers shorten this acronym to MRSA).
Staphylococci
_____ is a common inhabitant of human pharyngeal flora.
Haemophilus influenzae
is one of the smallest gram-negative bacilli, measuring about 1.5 mm in length and 0.3 mm in width
H. influenzae (Haemophilus influenzae)
It appears as coccobacilli on Gram stain.
Haemophilus influenzae
There are six types of ______, designated A to F, but only type B is commonly pathogenic.
H. influenzae
_____ is almost always the cause of acute epiglottitis
H. influenzae type B
Additional risk factors for _______ infection include COPD, defects in B-cell function, functional and anatomic asplenia, and human immunodeficiency virus (HIV ) infection.
H. influenzae
__ In July 1976, a severe pneumonia- like disease outbreak occurred at an American Legion con- vention in Philadelphia.
Legionella pneumophila
More than ___ Legionella species have now been identified.
20
Most of the species are free-living in soil and water, where they act as decomposer organisms. The organism also mul- tiplies in standing water such as contaminated mud puddles, large air-conditioning systems, and water tanks.
Legionella pneumophila.
The disease is most commonly seen in middle-aged men who smoke.
Legionella pneumophila
Enterobacteriaceae
(Klebsiella pneumonia) (Friedländer’s Bacillus)
______ organisms have long been associated with lobar pneumonia, particularly in men older than 40 years and in chronic alcoholics of both genders.
K. pneumoniae ( Klebsiella pneumonia )
___ is a gram-negative bacillus that is found singly, in pairs, and in chains of varying lengths.
Klebsiella
It is a normal inhabitant of the human gastrointestinal tract.
Klebsiella pneumonia
_______ is a common nosoco- mial, or hospital-acquired, disease. It is typically transmitted by routes such as clothing, intravenous solutions, foods, and the hands of health-care workers.
K. pneumoniae
______ is a highly mobile, gram-negative bacillus. It is often found in the gastrointestinal tract, burns, and catheterized urinary tract and is a contaminant in many aqueous solutions.
Pseudomonas aeruginosa
leading cause of hospital-acquired pneumonia
This makes ______ a particular problem for the respiratory therapist.
P. aeruginosa
P. aeruginosa grows in a very mucoid colonial form and the sputum from patients with ______ infection is frequently green and sweet smelling
Pseudomonas
The clinical presentation of the patient with ______ is often subacute.
community- acquired atypical pneumonia
The patient typically presents with a variety of both pulmonary and extra- pulmonary findings
Community-Acquired Atypical Pneumonia
The ______ organism is the most common cause of an acquired atypical pneumonia.
mycoplasma
The _____ are tiny, cell wall–deficient organisms
mycoplasma
They are smaller than bacteria but larger than viruses. The pneumonia caused by the mycoplasmal organism is commonly described as a ___
primary atypical pneumonia
The term ____ refers to the fact that (1) the organism escapes identification by standard bacteriologic tests, (2) there is generally only a moderate amount of sputum, (3) there is an absence of alveolar con- solidation, (4) there is only a moderate elevation of white cell count, and (5) there is a lack of alveolar exudate.
atypical
A common symptom of _______ is a cough that tends to come in violent attacks, producing only a small amount of white mucus. Some patients experi- ence nausea or vomiting.
mycoplasma pneumonia
is commonly seen among children and young adults. This type of pneumonia spreads easily in areas where people congregate, such as child-care centers, schools, and homeless shelters.
Mycoplasma pneumonia
Patients with M. pneumoniae often are said to have “_______” because the condition is mild and the patient is usually ambulatory.
walking pneumonia
Chlamydia spp. pneumonia
(Chlamydia pneumonia, Chla- mydia psittaci, Chlamydia trachomatis) and Coxiella burnetii (Q fever)
____ is a type of bacteria that may be found in the cervix, urethra, rectum, throat, and respi- ratory tract.
Chlamydia
___ is also found in the feces of a variety of birds (e.g., parrots, parakeets, lorikeets, cockatoos, chickens, pigeons, ducks, pheasants, turkeys).
Chlamydia
_____ account for about 50% of all pneumonias, and several are associated with a community-acquired atypical pneumonia.
Viruses
Although most viruses attack the upper airways, some can produce _____.
pneumonia